Here’s How Much Alcohol You Can Drink Without Hurting Yourself

For many of us, alcohol is an enjoyable backdrop
to life: wine with dinner, beers with friends, a glass of bubbly
to celebrate a special occasion, or nip of something heavier to
unwind after a long day.

But alcohol is the fourth-largest cause of disease in Australia
after excess weight, smoking and high blood pressure. So, how do
you decide whether — or how much — to drink?

Unfortunately, the answer is far from simple and falls into the
murky realm of "it depends."

Let's consider what the science says about the positive and
negative effects of alcohol.

Injury

Drinking alcohol increases your risk of accidents and injury.
Only tobacco outranks alcohol as the leading preventable cause of
drug-related death and hospitalisation in Australia.

Between 1992 and 2001, more than 31,000 deaths
were attributed to risky or high-risk alcohol consumption. And
between 1993–94 and 2000–01, half a million people were admitted
to hospital for alcohol-related injuries.

Cancer

The more you drink, the higher your risk of cancer — and this is
a steep exponential curve. So, with each incremental increase in
your drinking, there is a marked increase in your risk.

The World Health Organization's International Agency for Research on Cancer
has concluded there is "sufficient evidence" that alcohol causes
cancers of the oral cavity, pharynx, larynx, oesophagus, liver,
colorectum and female breast.

Unfortunately there is no evidence of a safe threshold; as soon
as you start drinking your risk of cancer increases. This
includes a 12% increase in the risk of breast cancer with
each additional unit of alcohol per day.

Heart disease

The evidence is mounting for a "J- or U-shaped" link between drinking alcohol
and developing cardiovascular disease (heart disease, stroke and
other blood vessel disease). This means light to moderate
drinkers have a lower risk of cardiovascular disease compared with
those who drink nothing and those who drink a lot.

Heart disease is the most common cause of death in Australia, which
makes the evidence on light to moderate alcohol consumption more
relevant than it otherwise might be.

Weighing up the risk

So, how do you weigh up alcohol's role in cancer, injury and
other risks with its beneficial effects on heart disease?

This is where things get tricky. We need to consider the balance
of risk and how it might apply to individual populations. What,
for example, is my likelihood of first getting cancer, compared
with my risk of liver disease, having an accident, being injured
or developing cardiovascular disease? The answer will be
different for everyone.

In younger men, accidents and injuries are leading causes of
death and cardiovascular disease is relatively uncommon.
Drinking, therefore, poses a greater threat to them
overall than the benefits it might afford. So they
really should limit their consumption, or, ideally, avoid alcohol
altogether.

The same is true for younger and middle-aged women, whose risk of
breast cancer is higher than their risk of cardiovascular
disease.

However, the cardiovascular health benefits of drinking are
likely to be more pronounced in older people, particularly those
aged in their 60s or above. It is interesting to note that
cardiovascular benefits don't seem to differ according to the
type of alcohol — wine, beer or spirits.

A moderate tipple

So if you are an older adult, and in an industrialised country,
the current evidence suggests the beneficial effects of
light to moderate alcohol consumption on cardiovascular
disease are likely to exceed your risk of cancer and
other conditions increased by alcohol. This means a moderate
tipple is likely to help in increasing your overall longevity.

But if cancer is the thing you are most concerned about, the
"don't drink at all" message should apply to you. And if you have
an alcohol dependency and an alcohol-related condition, it's
clear that cutting out drinking is the path you should take.

For most young men, the risks of drinking will outweigh
the benefits.

These messages are a hard sell. In many other areas of health
advice there is happy alignment between health organisations:
obesity and smoking being obvious examples. But in the case of
alcohol, what protects you against cancer is not necessarily best
for your heart.

This means people have to negotiate this tricky path without
clear signposts. It's no wonder some people find it all too hard.
Here it's worth returning to the alcohol advice from the National Health and Medical Research Council on
reducing the risk of disease:

Don't drink more than two standard drinks a day

Don't drink more than four standard drinks on one occasion

Don't drink while pregnant or breastfeeding

Don't drink if you are under 15. And if you're 15 to 17,
delay your first drink for as long as possible.

This advice is population-based, so any individual risk has to be
overlaid on top of it. But it is a good start point for guidance.

Reducing death

Finally, the question of how much alcohol would minimise the
overall risk of dying prematurely is different to asking what
role alcohol plays in the development of disease.

Most public health advice about alcohol, including that outlined
above, recommends upper limits of alcohol consumption but does
not actually encourage drinking. But the evidence, in fact, goes
a bit further. Taking individual risks and
priorities into account, it indicates that for people in
industrialised countries who have reached a later stage in their
life, drinking at least some alcohol (but not too much)
is likely to minimise the overall risk of premature
death.

Although it's difficult to make decisions about the health
effects of alcohol, we can be heartened by the fact that we have
large body of evidence to guide us.

Emily Banks has received funding from The National Health and
Medical Research Council of Australia, the Cancer Council, the
National Heart Foundation of Australia and the Australian Primary
Care Research Institute.